Menstrual Phase and Sexual Dysfunction After Concussion in Women

新出现的研究表明，脑震荡/轻度创伤性脑损伤后性功能的变化 (MTBI)在育龄妇女(18-45岁)中很常见。我的初步研究结果表明， 61.3%的脑震荡女性报告了性功能障碍(SD)--定义为性功能障碍 兴趣、欲望、性唤醒或满足感--相比之下，40%的肢体损伤对照有相似的月经和 节育状况。尽管脑震荡症状通常会在几周内消失，但这一系列研究 表明对于一组患者来说，症状可能持续数月甚至数年，并可能产生不利影响。 影响妇女健康和机能的一个重要但尚未得到充分研究的方面。 根据世界卫生组织(WHO)的说法，人类的性行为是健康的一个基本方面， “做人”的核心方面。性功能低下在性体验中假定为病理 唤醒、兴趣、欲望和反应，而且它与不利的身心健康有关。它 是生活质量(QOL)的标志。为减轻伤员的公共卫生负担，提高伤员的健康水平。 脑震荡妇女的临床护理，需要进行研究以确定妇女患脑震荡后的最大风险 脑震荡SD。理解脑外伤结果的性别差异和女性面临的独特挑战 脑外伤是神经病学国家神经疾病和中风研究所(NINDS)的优先事项。 这项K01申请提出了一项研究计划，将荷尔蒙生物标志物作为一种新的风险纳入其中 分层工具用于确定女性脑震荡患者的高危人群。研究参与者将使用 Ovia®数字生殖健康跟踪应用程序(APP)和其他经过验证的调查问卷，以记录 他们的性行为及相关协变量。 在目标1中，我们测试了这一假设，即与四肢受伤的女性相比，脑震荡的女性将 在性功能的BIQS测量中有较低的平均分，以及b)性行为较少 用Ovia APP报告，在受伤后1个月和3个月进行评估。 在目标2中，我们测试了在黄体月经期mTBI受损的女性是否会有更高的SD风险。 与卵泡月经期mTBI损伤的女性相比(BIQS平均得分较低，且 与APP的性行为)；以及在患有APP的女性中，这种关联的程度是否会显著更高 MTBI对于四肢受伤的女性来说要好于女性。 我将接受指导、职业建议和培训，以制定一个独立的研究计划， 将我的流行病学技能与我对神经学和生殖流行病学的兴趣联系起来。

Emerging research suggests that changes in sexual functioning after concussion/mild traumatic brain injury (mTBI) are common in women of reproductive age (18-45years). Findings from my pilot research show that 61.3% of women who sustain a concussion report sexual dysfunctions (SD)-defined as disordered sexual interest, desire, arousal or satisfaction-compared to 40% of extremity injured controls of similar menstrual and birth control status. Although concussion symptoms typically resolve within weeks, this line of research demonstrates that for a subgroup of patients, symptoms can linger into months if not years, and can adversely affect an important, yet understudied, aspect of women’s health and function. Human sexuality, according to the World Health Organization (WHO), is an essential aspect of health, a central aspect of “being human.” Poor sexual functioning assumes pathology in the experience of sexual arousal, interest, desire and response, and it has been associated with adverse physical and mental health. It is a marker of quality of life (QOL). In order to decrease the public health burden of mTBI and improve the clinical care of women with concussion, research is needed to identify women at greatest risk for post- concussion SD. Understanding sex-difference in TBI outcomes and the unique challenges faced by women with TBI is a priority for the Neurology’s National Institute of Neurological Disorders and Stroke (NINDS). This K01 application proposes a research plan that incorporates hormonal biomarkers as a novel risk stratification tool to identify high risk groups of female concussion patients. Study participants will use the Ovia® digital reproductive health tracking application (app) and other validated questionnaires to document their sexual activities and relevant covariates. In Aim 1 we test the hypothesis that compared to women with extremity injuries, concussed women will a) have a lower mean score on the BIQS measure of sexual function and b) have fewer sexual encounters reported with Ovia app, evaluated at 1& 3-months post-injury. In Aim 2 we test if women with mTBI injured during the luteal menstrual phase will have a higher risk of SD than women with mTBI injured during the follicular menstrual phase (lower mean score on BIQS and fewer sexual encounters with app); and if the magnitude of the association will be significantly higher for women with mTBI than for women with extremity injuries. I will receive mentoring, career advising and training to develop an independent research program that bridges my epidemiologic skillset with my interests in neurology and reproductive epidemiology.